For many children with asthma, flare-ups happen while at school. A quick-relief inhaler can reverse asthma symptoms, but what if the student forgets their inhaler at home and a parent is unable to retrieve it? In many schools, the only option is for the school personnel to call 911. But this doesn't have to be the case, if asthma inhalers are kept in stock.
Asthma is a chronic disease that affects 8.2 percent of children throughout the country, and each year asthma attacks lead to 750,000 emergency department visits and 200,000 hospitalizations. In fact, asthma is the third leading cause of hospitalizations in children.
While all 50 states and the District of Columbia have laws allowing students to carry and use asthma inhalers at school, schools need to move fast to save the life of a child during asthma emergencies. Situations may arise that can keep a child from getting the medications they need in a timely manner. Let's take a look at solutions that can help.
Students may forget their inhalers at home or the family can't afford a second inhaler to keep at school. Many states do not have laws nor do schools or school districts have policies in place that allow schools to keep school-owned inhaler medication at school. In these cases, school officials have to call the parents to go home to retrieve the inhaler. If they are unable to do so – because they can't leave work or their office is far from the school – the next step is to call emergency services.
"When students can't get albuterol right away, the episode is probably not going to resolve on its own," said Dr. Lynn Gerald, associate director for clinical research at the Asthma and Airways Disease Research Center at the University of Arizona, a member of the American Lung Association's Airways Clinical Research Centers. "Without access to albuterol, the episode may last longer and the child may have to go to the emergency room or be admitted to the hospital and will miss school for a few days or even a week."
An easy solution is to allow schools to stock albuterol medication. In 2008, Dr. Gerald and her team at the AADRC began working with a few school districts in Arizona to pilot stock albuterol programs. Within a year, the Sunnyside Unified School District saw a 20 percent decrease in 911 calls and a 40 percent drop in ambulance transports. Becky Zahn, a pediatric nurse at the Tucson Unified School District, said that having the medication on hand allowed her to easily treat students and then send them back to class.
"To have this lifesaving medication immediately available to treat children in distress is so reassuring to the child and the family," Zahn said. "Because we can use one inhaler for many children with the use of individual spacers, it is extremely cost effective. We can now continue to keep children at school and treat them while we help the family find resources to provide the care they need."
Arizona's state law was written so that only school nurses could administer asthma medicines to students. However, not every school district has nurses, as some districts have nurses that oversee several schools or are only part-time and not always available. Knowing how frustrating it is for school officials to not be able to help students when in distress and how effective stock albuterol programs are, Dr. Gerald decided to change the law.
Dr. Gerald went to the American Lung Association in Arizona for help and together they wrote a bill that allowed doctors to prescribe medication to the school directly. The bill also stated that trained school officials, outside of nurses, could administer the inhalers to students who were having an asthma episode. The legislation passed easily and became law in August 2017.
In preparation for the school year, Dr. Gerald and her colleagues are creating template protocols and policies to help schools in Arizona adapt the program and online trainings to teach non-medical licensed staff about asthma and administering the medicine. They are also helping schools learn ways to better work with children who have severe asthma or difficulty with adherence.
"Schools are incredible partners in improving the health of children, and I hope to continue working with them on such issues," she said.
Not all states have these commonsense asthma medication policies in place. While Arizona joins eight other states – Georgia, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, New York and Ohio – who have similar laws or policies on the books, other states lag behind in adopting stock albuterol programs in schools.
The Lung Association offers resources and model policies to help other states and school districts implement similar programs:
The Improving Access to Asthma Medications in Schools issue brief examines the policies and practices in schools and make recommendations on ways that schools, families and communities can better ensure that all students with asthma have quick, reliable access to medicines.